Influence of chronic kidney disease on the course, prognosis and treatment of myocardial infarction according to the Russian REGION-MI registry

Aim. To evaluate the prognosis of patients with myocardial infarction (MI) and chronic kidney disease (CKD) based on the data of the Russian registry REGION-MI, as well as to clarify the disease course and treatment of this group of patients in real-world practice.

Material and methods. REGION-MI is a Russian multicenter prospective observational study that included 10884 patients with acute MI. Data on creatinine levels and glomerular filtration rate (GFR) were obtained from 10229 people.

Results. Among patients included in the REGION-MI registry, a decrease in GFR <60 ml/min/1,73 m² was diagnosed in 30,5%. Patients with MI and CKD are significantly older than patients with preserved renal function, have a greater number of comorbidities. In addition, they were more often diagnosed with non-ST-elevation MI and were less likely to undergo coronary angiography and percutaneous coronary intervention. Patients with CKD were less likely to receive all groups of drugs prescribed after MI. Mortality of patients with CKD in our study was significantly higher compared to mortality of patients with preserved renal function both at the hospital stage (8,4% and 1,7%, respectively, odds ratio 5,31; 95% confidence interval: 4,25-6,62; p<0,005) and one year after the index event (10,1% and 3,6%, respectively, odds ratio 3,03; 95% confidence interval: 2,54-3,61, p<0,005).

Conclusion. A decrease in GFR is a factor influencing an increase in mortality in MI patients. Patients with CKD and MI have a very high risk of cardiovascular events, as well as require intensive care in the acute and late periods of the disease. However, they often do not receive drug therapy in full and are less likely to undergo coronary angiography and invasive treatment. Large clinical trials are needed to study the characteristics of the disease course and choose the optimal treatment tactics for patients with MI and reduced renal function.

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